Course Enrolment Form Name First Last Email address 1. Which area best describes your location of work?*a) Alice Springsb) Darwinc) Katherined) Nhulunbuye) Palmerstonf) Tennant Creekg) Other location in the Northern Territory (please describe below)h) Outside of the Northern TerritoryYour location in the Northern Territory:2. Which type of organisation best describes your workplace?*a) Alcohol and Drug Specialist Community/Out-patient Serviceb) Hospitalc) Other Healthcare Serviced) Other Community Servicee) Other (please describe below)Other:3. Is your workplace a:*a) Aboriginal Community Controlled Health Organisation (ACCHO)b) Government Departmentc) Not-for-profit serviced) Private Businesse) Other (please describe)Other:4. Which best describes your current role?*a) Aboriginal Health Workerb) Allied Health Practitioner (occupational therapist, physiotherapist etc)c) Case Managerd) Counsellor (psychologist, social worker, therapist, counsellor etc)e) Medical Practitioner (doctor, nurse)f) Other (please describe)Other:5. How long have you worked with people experiencing difficulties with their alcohol and/or other drug use?*a) Less than 12 monthsb) 1 – 5 yearsc) 6 – 10 yearsd) 10+ years6. What is your gender?*a) Maleb) Femalec) Intersexd) Othere) Prefer not to say7. What is your age group?*a) 19 years and underb) 20 – 29 yearsc) 30 – 39 yearsd) 40 – 49 yearse) 50 -59 yearsf) 60 – 69 yearsg) 70 +PhoneThis field is for validation purposes and should be left unchanged.